Form 1052 Public Provider Choice Request - Texas

What Is Form 1052?

This is a legal form that was released by the Texas Health and Human Services - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 1052?
A: Form 1052 is the Public Provider Choice Request form used in Texas.

Q: What is the purpose of Form 1052?
A: The purpose of Form 1052 is to request a change in public provider for healthcare services in Texas.

Q: Who can use Form 1052?
A: Any individual who receives healthcare services from a public provider in Texas can use Form 1052.

Q: How do I fill out Form 1052?
A: You need to provide your personal information, current public provider details, and the name of the new public provider you wish to choose.

Q: Is there a deadline for submitting Form 1052?
A: There is no specific deadline mentioned for submitting Form 1052, but it is recommended to submit it as soon as possible.

Q: Can I change my public provider multiple times using Form 1052?
A: Yes, you can change your public provider multiple times using Form 1052.

Q: What happens after I submit Form 1052?
A: After submitting Form 1052, your request for a change in public provider will be processed by the Texas Department of Health and Human Services.